Team-Based Care

Over the past few months, I've heard more and more about the patient-centered medical home (PCMH) model of healthcare. I typically think about healthcare models in the silos my physical therapy clinical rotations were centered on: inpatient, outpatient, or a skilled nursing facility. The idea of healthcare facilities as a "home" elicits a nostalgic and sympathetic response for me -- at last! Healthcare can be a collaborative home instead of an insurance-led, difficult-to-navigate entity.

So, what is a medical home? The idea started in the late 1960s by the American Academy of Pediatrics and has seen serious development in the past 10 years. A PCMH is a team-based delivery model led by an MD, PA or NP to provide comprehensive care to patients. The team facilitates continuity of care (majority of appointments are with the same provider/team), follow-up on referrals, full accessibility to care, and the use of evidence-based guidelines to improve quality of care.

As a physical therapist, I think this model sounds wonderful. Too often patients seem to get lost in the gaps of care and a home model may prevent those lapses. Being able to work with a patient and report my clinical findings right back to the patient's care team is how healthcare should be delivered. I think this works well in an inpatient setting already, but in outpatient there are physical and operational barriers to working as seamlessly together.

Several news outlets last week reported on recent study outcomes of the medical home model, with disappointing outcomes in reducing costs or improving quality. The studies compared 11 quality measures over three years and saw improvements in only one for the medical home models.

I'm interested to see how the medical home model evolves over the next few years. What do you think? Do you practice in a medical home? Do you see improvements in patient care compared to traditional models of healthcare practice?